I grew up in the age of “wonder” drugs. New discoveries for diseases that needed eradication. Dedicated researchers who had devoted decades to finding cures. Period. In the words of Jonas Salk, when asked about patents for his polio vaccine, he replied, “There is no patent. Could you patent the sun” and with those words the Salk vaccine eliminated – for the most part, polio. Albert Sabin developed the Sabin vaccine with the help of the Russians and it too was given freely – I received both while in grade school. I have never had polio. There was time when kids could not go swimming for fear of polio; couldn’t play with others for fear of polio and people whose lives were lived in a contraption called an “iron lung” that breathed for them. It was not a good thing. The moral compass and integrity of Jonas Salk and Albert Sabin pointed in a different direction and they found a cure that was made available to everyone. Polio is largely gone from the planet and with the efforts of the Gates Foundation may soon be simply extinct.

Doctors take the Hippocratic Oath which includes the words “First do no harm”. I don’t think it includes the words – do not treat those with no money. I could be wrong. I am not certain what Big Pharma swears to do – but one thing it knows how to do is make money. In my very skewed way of thinking if you are in the business of finding treatments and cures for deadly diseases, your motives should include making sure as many of those afflicted get them. My first hint of the slippery, slimy slope Big Pharma had chosen were the TV and print ads for prescription drugs – to the public. I couldn’t figure out whyBig Pharma was appealing directly to consumers for medications that had been the sole domain of the prescribing physician. And the laundry list of side effects – read by a serious voice – was a legal requirement. And scary. In print it required pages. Humans are gullible. We want quick fixes. Better, quicker fixes; an app for a cure. Sneeze? Wheeze, scratch, fidget, get the runs – watch and listen – an ad will tell you which med to “ask your doctor about”. (One appears to come with two free bathtubs but I am not sure). I have a suspicion doctors do not like to asked about these things. But Pharma spends a lot on consumer ads. Does this expand profit or eat into it. Someone should ask.

It used to be that Baby Boomers, who were usually old Hippies, had the PDR or the US Pharmacopeia stored away in their heads somewhere. I did. In the 60’s we knew who made what and the side effects, the contraindications and the uses to which these meds were put. Words like “sulfate, hydrochloride, spansules, tartrate and indole rings” flowed poetically from many of us who chose an alternative lifestyle. And FYI – the “meth” we spoke of was not the meth cooked in kitchen and garages. Ours came straight from drug companies; as my son used to say: “Back when drugs were good for you”. He was not far wrong. Such was our mindset. Bad drugs were cocaine and heroin. For me they still are.

Which takes us to 2014 and BIG Pharma – the profit stream that can mean life or death – your very own.

Recently a small “pharm” created a “cure” for Hepatitis C (for certain genotypes. and not a 100% cure – more like 95%). It made it through clinical trials, appeared and appears to be very beneficial and was approved for use by the FDA. Millions of us have this virus which didn’t even have a name before the 90’s. Millions didn’t know they had it. Millions still don’t. It is global. It is a slow progressor and can be asymptomatic for some and the virus is only interested in the liver. Unlike HIV – it does not wreak the same havoc with the immune system but many with HIV also have HCV and this is a horrid situation. Adding insult to injury. Unlike HIV (in its early days) HCV is possible to acquire by anyone who might be exposed through blood transfer. Unlike certain cancers it can afflict males or females equally. So,unlike many more publicized viral infections it can get lost in the shuffle. But if you have it – you could be facing cirrhosis, liver cancer or chronic fatigue and for many, a liver transplant. It is more complicated than this but that is a nutshell.

Voila!!! Someone finds a really effective oral treatment that can nail and rid many a body of it without the hideous side effects of previous treatments (interferon and ribaviran are two). A ORAL medication that is shown to be extremely effective, short regimen and now what? Oh, now here’s the price tag for this: $84,000 for an 84 day course. ACA, Medicare and insurance companies are not happy campers. I am not a happy camper. I have the right genotype and I have Medicare – but I am short about $84,000. Which brings me back to Big and small Pharma and their duty of care to cure if they can ,incurable diseases that will hugely reduce organ transplants, hospital care, rejection drug costs and generally better this country, both financially and medically . Do they even have a duty of care or do they first shun no profit. A drug company will tell us the costs for developing effective and important new drugs is astronomical – but who ever asks to see a breakdown of those costs? Seriously. The company I have in mind is publicly traded so showing investors a HUGE profit is, I suspect, far more important that cleaning up some sick livers. The Pharm contrasts the $84K spent to the cost of liver transplants but if this drug can reduce dramatically the need for this procedure, it makes more sense to dispense it to more people. And on the subject of liver transplants: donor organs are just that – donated. You cannot go to the doc and say – “okay let’s get me a new liver – when shall I come back” because you may never get one. So a liver transplant v. a high percentage cure is not a bet I would take to my turf accountant. I find it a specious argument.

But it gets better. Oh yes it does. It is perfectly legal for Pharma to sell pricey drugs to foreign countries at very discounted prices. Let’s say Egypt has a large load of cases of – let’s say – HCV – a pharm with a good product that can achieve maximum results can be had at a 90+% discount. Feeling edgy right about now? There’s more. Individual state Departments of Corrections can choose to give their felons and bad folks, let’s say, a certain high result drug for about a $3750 per inmate pop. So let’s say a slammer treats everyone – it could cost up to $315,000,000 to cover them all. Which takes us back to the duty to heal. The duty to cure. The duty to care? And my question is simply this: when does the humanitarian good exceed the addiction to profit. For me, right about now. It gets my goat.